Centre for Educational Development, Aarhus University, Trøjborgvej 82-84, 8000, Aarhus C, Denmark.
Faculty of Medicine, Centre for Teaching and Learning, Lund University, Margaretavägen 1B, 222 40, Lund, Sweden.
Adv Health Sci Educ Theory Pract. 2022 Oct;27(4):1067-1094. doi: 10.1007/s10459-022-10131-9. Epub 2022 Jul 27.
Participation in clinical work is important for medical students' professional development. However, students often report that they experience a passive observer role, and further research on contextual factors that influence student participation is needed. The theory of practice architectures contributes a new perspective to this challenge by elucidating how cultural-discursive, material-economic, and social-political arrangements enable and constrain student participation in clinical work. The aim of this study was to explore how practice architectures in clinical learning environments enable and constrain medical students' participation. The study was designed as an ethnographic field study in three student clinics: 106 h of observation. Analysis comprised ethnographic analysis followed by application of the theory of practice architectures. The ethnographic analysis resulted in six themes: setting the scene, when to call for help, my room - my patient, getting in a routine, I know something you don't, and my work is needed. Applying the theory of practice architectures showed that material-economic arrangements, such as control of the consultation room and essential artefacts, were crucial to student participation and position in the clinical workplace. Furthermore, co-production of a student mandate to independently perform certain parts of a consultation enabled a co-productive student position in the hierarchy of care-producers. The findings offer a conceptually generalisable model for the study of material and social dimensions of clinical learning environments. Although not all clinical learning environments may wish to or have the resources to implement a student clinic, the findings offer insights into general issues about the arrangements of student participation relevant to most clinical teaching contexts.
参与临床工作对医学生的专业发展很重要。然而，学生们经常报告说他们扮演的是被动观察者的角色，需要进一步研究影响学生参与的背景因素。实践架构理论通过阐明文化话语、物质经济和社会政治安排如何使学生参与临床工作成为可能并限制其参与，为这一挑战提供了一个新的视角。本研究旨在探讨临床学习环境中的实践架构如何使医学生参与并限制其参与。该研究设计为三个学生诊所的民族志实地研究：106 小时的观察。分析包括民族志分析，然后应用实践架构理论。民族志分析产生了六个主题：场景设置、何时寻求帮助、我的房间-我的病人、进入常规、我知道你不知道的事情、我的工作是必要的。应用实践架构理论表明，物质经济安排，如咨询室和基本器具的控制，对学生的参与和在临床工作场所的地位至关重要。此外，共同制定学生执行咨询某些部分的任务，使学生在护理生产者的层次结构中处于共同生产的地位。研究结果为研究临床学习环境的物质和社会维度提供了一个概念上可推广的模型。尽管并非所有临床学习环境都希望或有资源实施学生诊所，但这些发现为大多数临床教学环境中与学生参与相关的安排的一般问题提供了一些见解。
